ASSESMENT OF

ORGAN SYSTEM
FUNCTION: THE
THYROID
GLAND

ARAÑAS, MARIA SOFIA V.

APRIL 24,2019
Thyroid Gland
-Gland responsible for the production of 2 hormones involved in body
metabolism, neurologic development, and calcium homeostatsis.
 Thyroid hormone
 Calcitonin

Anatomy:
 Positioned in the lower anterior neck and shaped like a butterfly.
 Made up of 2 lobes, which is bridged by a structure called
isthmus.
 Parathyroid gland- regulates serum calcium levels.

Development:
• By 11 weeks of gestation, the thyroid gland begins to produce
measurable amount of thyroid hormones, which is critical to neurologic
development of the fetus.
• Iodine is an essential component of the thyroid hormone
▫ Recommended minimum daily intake = 150 ug/day ▫ @ <50 ug/day,
thyroid is unable to manufacture hormone
• Lack of iodine results to severe mental retardation and cretinism.

Histology & Hormone Production:

• Thyroid cells are organized into follicles.
• Follicular cells manufacture thyroglobulin, which is rich in the
amino acid tyrosine.
• Some of the tyrosyl residues can be iodinated, producing the
building blocks of the thyroid hormones.
Thyroid Hormone Synthesis
•Inside the thyroid cell, iodide diffuse across the cell to the apical side
which touches the colloid.
•Thyroid peroxidase (TPO) present in the membrane oxidize and bound
tyrosyl residues on thyroglobulin, resulting to the production of
monoiodothyronine (MIT) and diiodothyronine (DIT).
•TPO aids in the coupling of the residues to form triiodothyronine (T3)
and thyroxine (T4).
•Thyroid hormones are stored in the core of the thyroid follicle

Thyroid Hormone Metabolism

•80% of T4 is metabolized into T3 or reverse T3 (rT3) by iodothyronine-
5’deiodinase.
•T3 is 8-10x more metabolically active than T4 and is considered as the
active form of the hormone.
▫ T4 –prehormone
▫ Thyroglobulin–prohormone
▫ rT3 -metabolically inactive

Thyroid Binding Proteins

•When released, only 0.04% of T4 and 0.4% of T3 are bound by proteins.
3 major binding proteins
•Thyroxine-Binding Globulin (TBG)
•Thyroxine-Binding Prealbumin
•Albumin
•Measurement of the free hormone level may be necessary for
some individuals to eliminate confusion caused by abnormal
protein levels.
Thyroid Hormone Regulation
•Levels of thyroid hormones are regulated by the hypothalamic –
pituitary – thyroid axis.
▫ Hypothalamic hormone – TRH
▫ Pituitary hormone –TSH
▫ Thyroid Hormone –T3& T4
•This feedback loop requires a normally functioning hypothalamus,
pituitary and thyroid plus the absence of interfering agents.

Thyroid Hormone Action

•FT3 & FT4 travel across the cell membrane.
•T4 is deionidated into T3.
•T3 combines with its nuclear receptor which leads to the
production of mRNA.
•Proteins coded for by the mRNA influence metabolism and
development.
▫ Tissue growth
▫ Brain maturation
▫ ↑ heat producon
▫ ↑ oxygen consumpon
▫ ↑ B-adrenergic receptors
Disorders of the Thyroid
Hypothyroidism
• Low free T4 level with a normal or high TSH
• One of most common disorders of thyroid gland, occurring in
5–15% of women >65 years old
• Can lead to hyponatremia, anemia, hyperlipidemia
• Can be divided into primary, secondary, or tertiary disease
• Most common cause in developed countries is chronic
lymphocytic thyroiditis.
• Individuals should be tested beginning at age 35 & every
5 years thereafter; more frequently if risk factors are present.
• Treated with thyroid hormone replacement therapy

Thyrotoxicosis
• A constellation of findings that result when peripheral tissues
are presented with, & respond to, an excess of thyroid hormone
• Possible causes ▫ Excessive thyroid hormone ingestion ▫
Leakage of stored thyroid hormone from thyroid follicles ▫
Excessive thyroid gland production of thyroid hormone
(hyperthyroidism)
• Symptoms:
 Anxiety  palpitations
 emotional lability  heat intolerance
 weakness  perspiration
 tremor  weight loss
Graves’ Disease
• Most common cause of thyrotoxicosis
• An autoimmune disease in which antibodies are produced that
activate TSH receptor
• Features:
 Thyrotoxicosis  Ophthalmopathy
 Goiter  dermopathy
• Strong familial disposition:15% of patients have close relative with
this condition.
• Women are 5 times more likely than men to develop it.
• Lab testing shows high free T4and/or T3level with undetectable
TSH.
• Symptoms of ophthalmopathy:
 orbital soft tissue  proptosis, double
swelling vision
 injection of
conjunctivae
corneal disease
• Treatments
▫ Medication: beta-blockers, propylthiouracil, methimazole
▫ Radioactive iodine: destruction of thyroid tissue to make patient
hypothyroid; lifelong treatment with thyroid replacement therapy is
usually required
▫ Surgery: preferred in cases of thyroid cancer or to avoid eye
problems associated with radioactive iodine treatment
 Toxic Adenoma and Multinodular Goiter
• Caused by autonomously functioning thyroid tissue
• Neither TSH nor TSH receptor stimulating immunoglobulin is
required to stimulate thyroid hormone production.
• Associated with receptor mutations in some toxic nodules
• Occur in patients with hyperthyroidism & palpable nodules
• Treatment: surgery, radioactive iodine, or medication
Amiodarone-Induced Thyroid Disease
•Amiodarone is a drug used to treat cardiac arrhythmias
•Fat-soluble with a long half-life (50 days)
•37% of molecular weight is iodine.
•Effects ▫Inhibits thyroid hormone production (Wolff-Chaik off
effect) ▫Blocks T4 to T3 conversion
•Leads to hypothyroidism in 8–20% of patients & hyperthyroidism
in 3%
Subacute Thyroiditis
• Characterized by transient changes in thyroid hormone levels
• Associated with inflammation of thyroid gland, leakage of stored
thyroid hormone, repair of gland
• Three classifications
▫ Postpartum: occurs in 3–16% of women in postpartum
▫ Painless: similar to postpartum type, except with no
associated pregnancy
▫ Painful: characterized by neck pain, low-grade fever, myalgia,
tender diffuse goiter, swings in thyroid function test
References:
Clinical Chemistry Handbook by Maria Teresa T. Rodriguez, RMT, MAEd,
MSMT
Clinical Chemistry 7th Edition by Michael L. Bishop